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General NPI Number Information
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NPI Number | 1629332408
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Entity Type | Organization
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Legal Business Name | BASHA EYE GROUP PC
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Dates
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Enumeration Date | 06/27/2012
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Last Update Date | 06/27/2012
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Provider Practice Location Address
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Address Line | 27450 SCHOENHERR RD SUITE 200
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City | WARREN
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State | MI
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Zip | 48088-6683
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Country | US
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Telephone | 248-935-9280
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Fax | 248-282-5230
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Provider Business Mailing Address
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Address Line | 7032 KENDAL ST
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City | DEARBORN
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State | MI
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Zip | 48126-1854
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Country | US
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Telephone | 248-935-9280
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Fax | 248-282-5230
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Authorized Official
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Title or Position | OWNER
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Name | MAHDI BASHA
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Credential | DO
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Telephone | 248-935-9280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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